An ad promoting a trip to Glacier National Park

With the voting finally over, Americans may be as divided as ever, but at least we can celebrate together the end of campaign advertisements until the next election.

Our blood boils and we shake our heads with consternation that anyone could believe the most polished packages of political prevarication. Even ads for candidates we favor can grate as the same syrupy themes play over and over again.

With the voting done, political ads are gone, but that doesn’t mean our TVs are now ad-free or free from ads that mislead the unwary.

Among the prime offenders are drug companies who spend billions of dollars encouraging patients to prescribe for themselves or plead with their doctors for the latest treatment they’ve seen on television.

The worse the disease, the more desperate the patient, and the more likely they are to be swayed by anything that offers hope.

A case in point: a recent and frequent commercial for a combination immunotherapy promotes the use of two monoclonal antibodies for the treatment of advanced metastatic non-small cell lung cancer (NSCLC) that tests positive for PD-L1, so long as the patient doesn’t have abnormal EGFR or ALK genes.

What?

That describes a relatively small group of patients, and all of them are very, very sick. According to the American Cancer Society, five-year life expectancy for someone with NSCLC that has metastasized beyond the immediate region of the lungs is about 6%.

And what are all these acronyms? Very briefly, EGFR (Epidermal Growth Factor Receptor) and ALK (Anaplastic Lymphoma Kinase) genes provide instructions relative to cellular-level communication to and through the cell membrane.

PD-L1 refers to “programmed death-ligand 1,” a protein expressed by many tumors that interferes with the immune system’s ability to attack and kill the cancer cells.

Scientists have been able to create human-made proteins, called monoclonal antibodies, which target specific antigens on cancer cells in an attempt to neutralize their ability to block the immune system’s natural antibodies from attacking them. Visualize the drug as a defensive tackle who takes out the blocker in front of him so another defensive player can get through to the quarterback.

It has been a bit awe inspiring for me to read about the complex science behind these drugs while watching their development for the past decade. Several of them have been FDA approved for a variety of cancers.

They are not sure-fire miracle drugs, however. In some cases, the best they can do is to slow the cancer down or offer an alternative to chemotherapies. And they all have potential side effects that can be serious or even fatal.

You’ve probably seen the high-production-level ad mentioned above: a combination of OPDIVO (nivolumab) and YERVOY (ipilimumab) as treatment for advanced metastatic NSCLC that is PD-L1 positive – meaning the tumor expresses a protein that blocks the natural immune system. Both drugs are designed to neutralize that protein.

That’s terrific. But look more closely at the ad, which focuses on “a chance to live longer,” with “more days,” “more nights,” “more hugs,” “more small outings.” Actors are portrayed sailing, dancing and watching basketball together while inspirational music plays in the background.

If you pause the commercial at just the right spot, you can see fine print at the bottom, which explains why the commercial talks about more days and nights rather than more months and years. The data is based on a clinical trial that compared newly diagnosed patients who were treated either with the monoclonal antibody combination or with platinum-based chemotherapy.

After 14.9 months, half of the patients on chemotherapy had died, and half were still alive. Patients receiving infusions of the monoclonal antibodies took 17.1 months to reach the same point. In other words, half of the patients on chemotherapy lived at least 14.9 months, and half the patients on the antibodies lived at least 17.1 months.

The ad (and a promotional website) makes the claim “Opdivo + Yervoy reduced the risk of dying by 21% compared to platinum-based chemotherapy.”

That gives the impression that the therapy is 21 percent better at keeping you alive, but it doesn’t say for how long. For at least half of the patients, the difference in life expectancy is a couple of months, and with all the potential side effects, it’s unlikely those two months would be spent sailing.

Now, I’m all for living an extra two months if there’s any quality of life, but wouldn’t it be good to make clear what’s really on the table? The last half of the commercial consists of a government-required rapid reading of the most common side effects, but the viewer’s attention is drawn to happy people who apparently aren’t bothered by them.

I don’t know how the cost of immunotherapy compares to chemotherapy, but new treatments are generally more expensive than older ones, and drug companies naturally want to make back the money they spend on research and development, plus a lot more.

But do they have to spend so much on marketing? A study by Global Data showed that in 2017, the top 10 drug companies spent $47.5 billion on sales and marketing. That’s billion, and it’s not far from what the same companies spend on research and development.

Wouldn’t it make better ethical sense for drug companies to put their marketing money into lower drug prices – and for patients to trust their doctors for medical advice, rather than TV commercials?

Drug advertising may be legal, even when it’s misleading, but what’s good for company profits isn’t necessarily good for consumers who may or may not become healthier but will almost certainly become poorer.

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